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General NPI Number Information
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NPI Number | 1760006845
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Entity Type | Individual
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Provider Name | SHANNON MARKS
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 7100 W 13TH AVE APT 213
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City | LAKEWOOD
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State | CO
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Zip | 80214-4782
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Country | US
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Telephone | 303-770-4682
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 ROCKMONT DR APT 6103
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City | DENVER
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State | CO
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Zip | 80202-2096
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Country | US
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Telephone | 267-885-5250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Q00000X
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Taxonomy Name | Pathology Specialist/Technologist
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License Number | SLP.0004761
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 246Q00000X
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Taxonomy Name | Pathology Specialist/Technologist
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License Number | SL015059
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License Number State | PA
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